| NPI | 1033868930 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOSE MATEO GOMEZ Credentialing Consultant 248-470-8918 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YA0400X Counselor, Addiction (Substance Use Disorder) |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2022-03-20 |
| Last Update Date | 2025-06-10 |